What is abusive head trauma – and how is it different from shaken baby syndrome?

Abusive head trauma (AHT) and shaken baby syndrome usually refer to the same thing. When a caregiver shakes and injures a child, it's sometimes called shaken baby syndrome.

Shaking a baby is the most common form of AHT. It occurs most frequently in babies younger than 1 – typically when an adult is overwhelmed by a crying baby and tries to get him to stop. It can happen when an adult is frustrated with a toddler or preschooler, too.

AHT is also the term doctors use to describe a serious brain injury that results from blunt force. Receiving a blow to the head and being thrown or dropped cause similar injuries to violently shaking a child, so doctors refer to all such injuries as AHT.

When a child's head is shaken back and forth, his brain bumps against the skull, causing bruising, swelling, pressure, and bleeding in and around the brain. The impact often causes bleeding in the retina – the light-sensitive portion of the eye that transmits images to the brain.

A child with AHT may also have a damaged spinal cord or neck as well as bone fractures. The extent of the damage depends on how long and hard the child is shaken or how severe the blow to the head is. But in just seconds, a child can suffer severe, permanent damage or even death.

Could abusive head trauma happen accidentally while I'm playing with my child?

The normal ways that most parents interact with their children don't cause AHT. Bouncing a baby on your leg, swinging him in his swing, jiggling a child in your arms, or tossing him gently in the air won't cause AHT. An accidental fall is also extremely unlikely to cause the condition.

AHT results from a deliberately violent back-and-forth motion. Unfortunately, an angry adult can quickly unleash that degree of violence on a baby or a small child.

Does abusive head trauma only happen to babies?

Most abusive head injuries happen to babies younger than 1 year old (and most to infants younger than 4 months). But sometimes kids as old as 5 get AHT.

Babies and young children are especially vulnerable to this kind of injury because their head is proportionally larger than the rest of their body, and their neck muscles are relatively weak, making it harder to support their large head.

A baby's immature skull is thinner, and his blood vessels are more susceptible to tearing than those of older children and adults. Babies younger than 1 also have a flatter skull, which allows for more sheering force when a baby is shaken.

How common is abusive head trauma?

An estimated two to three babies out of 10,000 are victims of AHT in the United States each year. About one in five of these babies dies, and only about a third will survive without severe disabilities.

Boys are shaken more often than girls, and it's usually a parent or parent's partner who does the shaking. Most often a father, stepfather, or boyfriend abuses the child.

A study published in 2011 looked at data from children's hospitals in four states and found a worrisome increase in the number of AHT brain injuries during the economic recession that began in December 2007. Poverty and stress are risk factors for child abuse, which may explain the rise in AHT during hard economic times.

What happens to a child with abusive head trauma?

It depends on how long and hard the child has been shaken or the extent of the child's other head injuries. Some of the most common effects include:

eye damage or blindness

hearing impairment

speech disabilities

damage to the neck and spine

learning disorders

intellectual disability

behavioral problems

permanent vegetative state

developmental problems

seizures

cerebral palsy

death

What are the signs of abusive head trauma?

The signs of abusive head trauma depend on the extent of the damage. The most common signs include:

not eating or difficulty feeding

rigidity

glassy eyes

unable to lift head

unable to focus on an object

vomiting

lethargy

irritability

As brain cells are destroyed and oxygen is depleted in the brain, neurological changes continue to occur. In severe cases, a child may have difficulty breathing or suffer from seizures or heart failure. He may lose consciousness and become comatose.

Call 911 immediately if you ever suspect that your child has AHT. Moments can make a big difference in the extent of the damage your child suffers.

If you find yourself getting angry or frustrated with your baby, take a deep breath, gently place him in a safe place (like a crib or bassinet), leave the room, and try to calm down.

Remind yourself how young, helpless, and vulnerable your child is. It's normal for babies to cry, and crying jags may be very intense in a young baby. But caring for your baby will get easier as time goes by, and before you know it, this stage will be over.

If you feel that you can't control your anger, call a friend or relative to come and stay with your baby for a bit. Take a walk or a shower if you think that might help you.

If there's nobody you can call to come and support you in person, call the National Child Abuse Hotline at (800) 422-4453 (800-4-A-CHILD) to talk with a crisis counselor.

You also can search online for crisis intervention services and hotlines in your area. The people who staff these phones are available 24 hours a day and know how to help you.

If you often struggle with frustration or anger over your baby's crying, seek help from a counselor.

Also, be selective about your baby's caregivers. Make sure that everyone who takes care of your child knows that it's never okay to shake a baby. And if you ever suspect that someone in your home or at your baby's childcare facility may be abusing your baby or any other child, don't ignore your instincts.

Have your baby checked out by a doctor, and don't leave him with the person you suspect. Take steps to either confirm (and report) or eliminate your suspicions. You may want to read our article on steps to take if you suspect child abuse.

What should I do if I know my child has been abused?

Call 911 immediately. Don't let guilt, fear, or anger keep you from helping your child. Get medical attention right away – it may save your child's life or keep him from developing severe mental and physical handicaps.

If your child stops breathing before medical help arrives, give him CPR. If he's vomiting, turn his head to the side so that he doesn't choke, unless you think that his neck or spine is injured. In that case don't move him.

The emergency medical staff at the hospital need to know immediately that your child has been shaken or has suffered head trauma. Otherwise, making an accurate diagnosis can be difficult because some symptoms of AHT are also symptoms of other common illnesses (including the flu or a viral infection). Don't waste valuable moments waiting for doctors to figure out what's wrong with your child.

Doctors may do X-rays, a CT scan, or magnetic resonance imaging to get a clear picture of what's going on in and around your child's brain. Once they determine the extent of the damage, they can decide on the best course of action for your child.

If necessary, they'll put him on a respirator to help him breathe. Emergency surgery may be necessary to stop any internal bleeding.

Where can I go for support?

If your child has suffered AHT, or if you want to learn more about the condition, you may find this resource helpful:

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